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INJURY
Second-Messenger Systems and Neurotransmitters
Second messengers are large molecules, usually situated within the neuronal membrane or
adjacent to its inner surface within the cytoplasm, that have the capability of modulating or
amplifying external signals brought to the cell via neurotransmitters and mediators, such as
glutamate, adenosine, steroids, and acetylcholine. A number of studies have shown that secondmessenger systems, probably because of their large molecular size and the complexity of their
stearic interactions, are vulnerable to the shear forces of neurotrauma. In some circumstances,
second-messenger systems may be amplified (up to 200-fold or more) by neurotrauma, whereas
other types of second messengers are downregulated or deactivated. It is thought that such
systems may play an important role in complex neurological processes, such as encoding of
memory, and thus these changes in second-messenger systems could constitute a mechanism for
the behavioral and memory changes that occur in both animals and humans after neurotrauma. In
the central fluid percussion model, few or no anatomic changes are seen in the presence of these
long-lasting neurobehavioral deficits.
Acetylcholine production has been reported to be upregulated in brain tissue and cerebrospinal
fluid after TBI in humans and experimental models. Although postmortem studies of injured
patient brains have revealed a marked reduction in choline acetyltransferase activity in the
temporal cortex, preservation of muscarinic receptor binding sites supports the view that the
reduced choline acetyltransferase may be associated with cognitive impairment in survivors of
head injuries. It has also been suggested that cholinergic mechanisms may be responsible for the
cognitive dysfunction in experimental models of TBI. Finally, it has been proposed that changes
in catecholamine and monoamine neurotransmitters after head injury may be indicators of the
severity of brain damage. Changes in tissue concentrations of dopamine, noradrenaline, and
adrenaline have been found in experimental models of TBI.
Produksi asetilkolin dilaporkan diregulasi dalam jaringan otak dan cairan serebrospinal setelah
TBI pada manusia dan model eksperimen. Meskipun studi postmortem otak pasien cedera telah
mengungkapkan pengurangan penanda aktivitas asetiltransferase kolin di korteks temporal,
pemeliharaan reseptor muscarinic situs pengikat mendukung pandangan bahwa penurunan kolin
asetiltransferase dapat dikaitkan dengan gangguan kognitif pada penderita cedera kepala. Ini juga
telah menyarankan bahwa mekanisme kolinergik mungkin bertanggung jawab untuk disfungsi
kognitif dalam model eksperimental TBI. Akhirnya, telah diusulkan bahwa perubahan
neurotransmitter katekolamin dan monoamine setelah cedera kepala dapat menjadi indikator
tingkat keparahan kerusakan otak. Perubahan konsentrasi jaringan dopamin, noradrenalin, dan
adrenalin telah ditemukan dalam model eksperimental dari TBI.